Healthcare Provider Details

I. General information

NPI: 1154852416
Provider Name (Legal Business Name): TOLANI ADEYINKA OGUNYOKU MAED, LMHCA, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 114TH AVE SE # 101
BELLEVUE WA
98004-6942
US

IV. Provider business mailing address

1300 114TH AVE SE # 101
BELLEVUE WA
98004-6942
US

V. Phone/Fax

Practice location:
  • Phone: 435-467-7033
  • Fax:
Mailing address:
  • Phone: 435-467-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: